Rural Vermonters - Especially Parents with Sick Children - Need Paid Leave to Manage Distances to Hospital-Based Care

Expanding access to paid family and medical leave in Vermont is a live issue in the legislature in 2023. New data shows that rural Vermonters – who make up nearly two-thirds of the state's population now, up from 61 percent in 2010 – have a particular need for paid leave. Access to paid leave promotes health, strengthens workers' economic security, and helps to support a larger workforce.

Vermont is one of two states with large rural populations that currently require employers to provide workers with earned paid sick time of up to five days per year. Most states with paid sick days laws have also enacted paid family and medical leave programs. Vermont could be next.

Access to Paid Leave

In Vermont, job-protected unpaid leave is available and accessible to only 35 percent of workers, according to researchers from Brandeis University. And without paid family leave through their jobs, which just 28 percent of New Englanders have according to the U.S. Bureau of Labor Statistics, parents must leave newborns and newly adopted children too soon, and family members must struggle to find or provide care for loved ones. Paid medical leave is also rare, which means that many seriously ill or injured workers must return to work too soon after a serious health issue if they’re able to take workplace leave at all, or might leave their jobs altogether.

Rural workers have even less access to both employer-provided paid family leave and paid sick leave than workers in metropolitan areas because the types of jobs that are most prevalent in rural communities are less likely than others to offer paid leave benefits. A large study of cancer patients in Vermont found that rural Vermonters were less likely to report using paid disability (medical) leave; they were also less likely to return to work after their cancer diagnosis than patients in metro areas, in part because the kinds of jobs that are common in rural Vermont involve physical labor, have fewer return to work options, and do not offer paid leave benefits. Instead of staying in Vermont's workforce, these cancer survivors retired early.

Rural workers also have reduced access to job-protected unpaid leave through the Family and Medical Leave Act of 1993 (FMLA) because they tend to work for smaller employers and are more likely to work part-time.

Lack of access to paid leave can force impossible choices between keeping a job, feeding a family, and getting or helping a loved one to get the health care they need.

Distances to Hospital-Based Health Care Services

In late 2022, the Better Life Lab at New America released a report, Health, Work, and Care in Rural America, tying together new analyses of rural disparities in access to paid leave and new calculations demonstrating the long and disparate distances that rural people must travel to seek specific types of hospital-based health care services. We found that people in rural communities must travel three to five times as far as people in urban areas to receive hospital-based care. [1]

New state data analysis augments our national findings: Rural Vermonters must travel up to 3.6 times further, on average, than people in urban areas to get to hospital-based health care. The distance disparities are greatest for parents and caregivers of babies in the NICU or receiving other neonatal care: rural NICU services are an average of 50 miles from rural census tracts but just under 14 miles from urban areas. In a small state, 50 miles is a very long distance. Similarly, hospital-based pediatrics care is more than 30 miles from rural census tracts, but 13 miles from urban ones.

Hospital-based cancer treatment and cardiac care is also nearly twice as far for rural Vermonters than urban ones – more than 20 miles, on average, compared to 11 miles. Distance disparities for obstetrics care and hospital-based cancer screening are smaller, but can still pose substantial barriers in bad weather and on windy roads or when time is of the essence.

Native Americans in rural Vermont often must travel even further than other rural residents, on average, for obstetrics care (21 miles), pediatric care (41 miles) and cancer screening (21 miles). [2]

Implications: Comprehensive Paid Leave Will Strengthen Rural Vermont

Hospital distances and lack of paid leave together have significant implications, especially for people in rural communities where measures of good health are lower and where caregiving needs are higher. For example, research cited in our main national report shows that rural cancer patients better able to return to work when they have paid leave and workplace flexibility, that hospitalized children recover more quickly when a parent can be at the hospital with them, and that cancer treatment recommendations are followed more closely when patients and caregivers have and use paid leave. Additional research shows that paid leave contributes to workforce retention for new parents and caregivers and higher earnings for mothers; positive impacts for businesses; and, as a result, improves the potential for economic growth.

Vermont's governor is currently planning to replicate New Hampshire's voluntary paid leave plan, which would incentivize employers to purchase paid family and medical leave through a private insurance company, but fail to guarantee paid leave to anyone who works for a private company. A voluntary approach is unlikely to be cost-effective or achieve substantial expansions in access for workers, especially those in rural areas where benefits are less commonly provided to workers and in smaller employers.

State legislators are considering a different approach that is similar to 11 states and the District of Columbia. Rural workers would benefit most from the comprehensive, inclusive approach used in these states, drawing on best practices regarding wage replacement, family caregiving coverage that includes an extended set of loved ones, and job protection for all workers using paid family and medical leave.

Hannah Friedman, a doctoral candidate in the Department of Health Policy and Management at the Gillings School of Global Public Health and The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, provided the Vermont hospital-distance data analysis used in this blog.

[1] Distances to hospital-based health care services are measured from the middle of each census tract. Census tracts are classified as rural or metropolitan using RUCA codes. Data on hospital services is from the American Hospital Association Survey. Files used for mapping are from the National Historical Geographic Information System. For more information on our methodology, please see descriptions in Health, Work, and Care in Rural America.

[2] Census tracts in this subgroup analysis are those that fall into the top 10 percent of census tracts nationwide with concentrations of Native American/Pacific Islanders. For more information, please see the methodology in Health, Work, and Care in Rural America.